Sperm collection

If sperm cannot be collected by means of masturbation, they
are surgically removed from a
testicle through a small incision. This method may be used when there is a blockage that prevents sperm from being
ejaculated or when there is a problem with sperm development. To screen for
genetic problems that could affect offspring, experts recommend that
men with little or no sperm in their semen (not due to a blockage) have genetic
testing before they start ICSI.1

Ovulation and egg retrieval

To prepare for a procedure using your own eggs, you must get daily
shots and be closely monitored for 2 weeks before the eggs are collected. At home,
you or your partner injects you with gonadotropin or
follicle-stimulating hormone (FSH) to stimulate your
ovaries to produce multiple eggs. This is called superovulation. After the first week,
your doctor checks your blood estrogen levels and uses
ultrasound to see if eggs are maturing in the
follicles. During the second week, your dosage may
change based on test results and ultrasound. If follicles fully develop, you
are given a human chorionic gonadotropin (hCG) shot to stimulate the
follicles to mature. The mature eggs are collected 34 to 36 hours later. This is done using
laparoscopy or needle aspiration guided by ultrasound
through the belly to the ovaries.

Sperm injection and transfer

A glass tool
is used to hold an egg in place. A tiny glass tube
is used to put one sperm
into the egg. After culturing in the lab overnight, eggs are checked to see if they've been fertilized. After incubation, the eggs that have been
successfully fertilized or have had 3 to 5 days to further develop
are selected. Two to four are placed in the uterus
using a thin flexible tube (catheter) that is inserted through the cervix. The
other embryos may be frozen for future use.

What To Expect After Treatment

The shots, monitoring, and procedures for in vitro fertilization (IVF) can be emotionally and
physically demanding of the mother.
Superovulation with hormones requires regular blood
tests, daily shots, and frequent monitoring by
your doctor. Some of the shots can be quite painful.

These procedures are done on an outpatient basis. They
require only a short recovery time. Your doctor may advise you to avoid
strenuous activities for the rest of the day.

Why It Is Done

ICSI is used to treat severe male infertility, as when little or no sperm are
ejaculated in the semen. Immature sperm collected from the testicles usually can't move about and are more likely to fertilize an egg through
ICSI.

ICSI can be used even if a couple's infertility is not related to a problem with sperm. Some couples choose to try ICSI after repeat in vitro
fertilization has not worked.

ICSI is also used for couples who are planning
to test the embryo for certain
genetic problems. ICSI uses only one sperm for each
egg. So there is no chance the genetic test can be contaminated by other
sperm.

How Well It Works

Used with in vitro fertilization and
eggs of good quality, ICSI often is successful for men who have
impaired or no sperm in the ejaculate. ICSI (using sperm collected from the
testicles) produces an estimated 25% to 30% birth rate.2

The risk of conceiving a multiple pregnancy is directly related to the number of embryos transferred to a woman's uterus. Multiple pregnancies are high-risk for both a mother
and her fetuses.

There may be a higher risk of birth defects for babies conceived by certain assisted reproductive techniques, such as ICSI. Talk with your doctor about these risks.

Treatment success versus the risk of multiple pregnancy

For a woman over age 35 to maximize her chances of
conceiving with her own eggs and having a healthy pregnancy, she may choose
to have more embryos transferred than a younger woman would. But this increases
her risk of multiple pregnancy.

Because of the risks to the babies of multiple
pregnancy, experts recommend that you limit the number of embryos transferred. Your doctor will recommend a certain number of embryos based on your age and other factors.

Women over 40 have a high rate of embryo loss when they use their own
eggs. Donor eggs may work better these women.

What To Think About

Doctors advise men who have little
or no sperm in their semen (not due to a blockage) to have genetic testing
before ICSI.1 ICSI is an effective treatment for sperm-related infertility. But it
may have genetic risks. Couples who have a chromosomal problem can seek
genetic counseling to learn their chance of having a child with birth
defects.

If you and your doctor are concerned about passing on a
genetic disorder to your child, talk to your doctor about testing the embryo before it is transferred to the mother.

Frozen embryos are often less expensive and
less invasive for a woman, because superovulation and egg retrieval aren't
needed.

References

Citations

American Society for Reproductive Medicine and Society for Male Reproduction and Urology (2008). Evaluation of the azoospermic
male. Fertility and Sterility, 90(Suppl 5):
S74–S77.

American Society for Reproductive Medicine and Society for Male Reproduction and Urology (2008). The management of infertility due to obstructive azoospermia.
Fertility and Sterility, 90(Suppl 3):
S121–S124.

American Society for Reproductive Medicine and Society for Male Reproduction and Urology (2008). Evaluation of the azoospermic
male. Fertility and Sterility, 90(Suppl 5):
S74–S77.

American Society for Reproductive Medicine and Society for Male Reproduction and Urology (2008). The management of infertility due to obstructive azoospermia.
Fertility and Sterility, 90(Suppl 3):
S121–S124.

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